Cancer Diagnosis--Hospice Care For Persons With Cancer

What is hospice care?

Hospice is a type of palliative care that provides services to improve the quality of life for the patient and family. The word "hospice" literally means "a place of shelter." Hospice settings and home-hospice care provide extensive services to terminally ill patients. Care usually involves relieving symptoms and providing psychological, spiritual, and social support. To qualify for hospice care, a patient usually has a life expectancy of less than six months. The hospice philosophy provides for the spiritual and cultural needs of the patient and family. The goal of hospice care is to provide the terminally ill patient peace, comfort, and dignity at the end of life.

Research has shown that hospice care at home helps the family as a whole. In addition to being in the comfort of the home, family members can also take an active role in providing supplemental, supportive care to the patient. Hospice often includes an extensive multidisciplinary team available for care, including physicians, nurses, social workers, chaplains, home care aides, trained volunteers, pharmacists, and bereavement counselors.

Settings for hospice care

Although most patients receive hospice care at home, hospice care can also take place in other settings, including:

Hospital-based hospiceMost hospitals have a hospice program to give terminally ill patients access to support services and other healthcare professionals. Some hospitals even have a special hospice unit. In addition, the hospital can serve as a place for respite care. A few hospices are certified to provide acute care.

Long-term care hospiceMany long-term care homes have hospice units with specially trained staff for those patients who require medical services not suitable for a home setting. A hospice team can sometimes provide hospice care to patients who are placed in nursing homes or other long term care facilities.

Freestanding hospiceIndependently owned hospices might sometimes include an inpatient care facility, in addition to their home care hospice services. The inpatient facilities offer patients hospice services if the patient requires medical services not suitable for a home setting.

What are the different types of hospice care services?

Hospice care, unlike home health care, provides treatment to manage pain and symptoms associated with a terminal illness. In addition, hospice care gives support--emotionally, spiritually, and socially to the patient and the family. The goal of hospice is to provide comfort and care, not "cure" the illness or disease, like home health care. Types of hospice care services provided depend on the patient's needs and preferences. Services may include:

Nursing careIn consultation with the physician, a registered nurse will set up a plan of care. Nursing care may involve administering medication, monitoring the condition of patient, controlling pain and other symptoms, and providing other health support, as well as assessing the patient's condition.

Medical social servicesMedical social workers provide various services to the patient, including counseling and locating community resources to help the patient and his or her family. Some social workers are also the patient's case manager when the patient's medical condition is very complex and requires coordination of many services.

Physician servicesThe physician plays an important role in determining the plan of care with the hospice care team, writing prescriptions, and supervising medical aspects of care.

Spiritual servicesDepending on the patient's religious or spiritual beliefs, hospice care can include support from clergy or other spiritual counselors for the patient and the family. Hospice staff will work with the patient's personal clergyman.

Home care aide or homemaker servicesHome health aides can help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing. Some aides have received specialized training to assist with more specialized care under the supervision of a nurse. A homemaker or attendant can help with meal preparation, laundry, grocery shopping, and other housekeeping chores.

24-hour care or on-call careIn addition to scheduled visits, hospice care teams are usually available 24 hours a day, seven days a week. Visits or phone consultations can often be made any time of day.

Hospice inpatient careAt times, it may become necessary to move the hospice patient from the home to a hospital or other care facility. The hospice can arrange this care and then resume hospice care when appropriate.

Volunteer careVolunteers are often part of hospice care teams, providing services ranging from companionship to carpooling. Volunteers often fill in the gaps for families dealing with a terminal illness and provide support for both the patient and the family.

Physical, occupational, and/or speech therapyAs a terminal illness progresses, the patient may lose his or her ability to accomplish basic daily tasks such as dressing or feeding. Physical, occupational, and/or speech therapists can work with the patient to find new ways to accomplish lost functions.

Respite careCaring for a terminally ill patient 24 hours a day can be exhausting for a family. Respite care gives the family a much-needed break by arranging for a brief in-patient stay for the patient, or extra services in the home.

Bereavement supportCare for the family does not end with the death of a patient. The hospice care team works with the surviving family members to help them cope with the grieving process. Bereavement support may include counseling, support groups, or medical referrals, and can begin for the family in advance of the anticipated death.